Thrombotic and bleeding complications in patients with AL amyloidosis

Haemostatic abnormalities and deregulated coagulation are common complications in AL amyloidosis. The relevant risks of thromboembolic and haemorrhagic events have not been thoroughly evaluated. To describe clinically significant thrombotic/haemorrhagic events in 450 consecutive patients with AL amy...

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Vydáno v:British journal of haematology Ročník 204; číslo 5; s. 1816 - 1824
Hlavní autoři: Fotiou, Despina, Theodorakakou, Foteini, Spiliopoulou, Sotiria, Gavriatopoulou, Maria, Migkou, Magdalini, Kanellias, Nikolaos, Eleutherakis‐Papaiakovou, Evangelos, Malandrakis, Panagiotis, Dialoupi, Ioanna, Roussou, Maria, Ntanasis‐Stathopoulos, Ioannis, Terpos, Evangelos, Dimopoulos, Meletios A., Kastritis, Efstathios
Médium: Journal Article
Jazyk:angličtina
Vydáno: England Blackwell Publishing Ltd 01.05.2024
Témata:
Adult
Aged
Aged, 80 and over
Amyloidosis
Amyloidosis - blood
Amyloidosis - complications
Amyloidosis - mortality
Bleeding
Creatinine
Female
Follow-Up Studies
Hemorrhage
Hemorrhage - etiology
Humans
Immunoglobulin Light-chain Amyloidosis - blood
Immunoglobulin Light-chain Amyloidosis - complications
Immunoglobulin Light-chain Amyloidosis - mortality
Male
Middle Aged
Platelets
Proteinuria
Risk Factors
Thromboembolism
Thrombosis
Thrombosis - etiology
AL amyloidosis
bleeding risk
arterial embolic events
venous thromboembolism
ISSN:0007-1048, 1365-2141, 1365-2141
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Shrnutí:Haemostatic abnormalities and deregulated coagulation are common complications in AL amyloidosis. The relevant risks of thromboembolic and haemorrhagic events have not been thoroughly evaluated. To describe clinically significant thrombotic/haemorrhagic events in 450 consecutive patients with AL amyloidosis. Venous thromboembolic events (VTEs) were reported in 6% and arterial embolic events (AEEs) in 5% of patients, respectively, during a 55‐month median follow‐up. Lower albumin, lower eGFR, higher BM infiltration, soft tissue involvement, IMiD‐based therapy and prior thrombosis were associated with VTE risk. Prior thrombosis was the only independent prognostic variable (HR 9.3, p  = 0.001). Coronary arterial disease, prior AEE, 24‐h proteinuria and higher platelet counts were associated with AEE risk. Significant bleeding events were reported in 9%, and associated mortality was 19%. Liver involvement, higher serum creatinine and higher baseline VWF:Ag levels were linked to bleeding risk. Using competing risk analysis, the cumulative probability of thrombosis/bleeding was higher during the first year following diagnosis, but a stable lower risk for both events remained for the duration of follow‐up. In AL amyloidosis patients, the risk of thrombotic/arterial embolic events is significant, but the bleeding risk is also high. A multiparametric assessment is required to initiate anti‐thrombotic or anti‐platelet therapy appropriately.
Bibliografie:ObjectType-Article-1
SourceType-Scholarly Journals-1
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ISSN:0007-1048
1365-2141
1365-2141
DOI:10.1111/bjh.19331